Three cases of flying personnel with tuberculous meningitis and literature review

Abstract

Objective To investigate the clinical features and aeromedical assessment of the flying personnel with tuberculous meningitis. Methods Clinical data of three cases of tuberculous meningitis diagnosed by the Center of Clinical Aviation Medicine of Air Force General Hospital from June 1996 to May 2014 were retrospectively analyzed and the literatures were reviewed to summarize the clinical features, diagnosis, treatment and aeromedical assessment. Results Case 1, which was with atypical symptoms and cerebrospinal fluid was misdiagnosed as viral encephalitis while the tuberculosis smear was positive in cerebrospinal fluid. He took anti-tuberculosis treatment (isoniazid, rifampin, pyrazinamide, levofloxacin) for 2 years and was qualified after drug withdrawal for 1 year and a half, but he relapsed 3 years later. He was qualified after following 2-year treatment (isoniazid, rifampin, protionamide, levofloxacin). Case 2 was with typical symptoms, tuberculosis smear-positive and lumbar tuberculosis and was treating with anti-tuberculosis treatment (isoniazid, rifampin, pyrazinamide, moxifloxacin) and steroid early. He was temporarily unqualified during the treatment. Case 3 was with atypical symptoms, high cerebrospinal fluid pressure and tuberculosis smear-negative and was treated by anti-tuberculosis drugs (isoniazid, rifampin, pyrazinamide, ethambutol). He was qualified finally as the symptoms got better after treatment. Conclusions Clinical manifestations and laboratory tests of tuberculous meningitis are not typical. Aircrews have better physical fitness, so the onset of performance is more subtle. Careful observation and analysis of clinical manifestations are important for deciding diagnosis, as well as the early diagnosis and misdiagnosis avoidance. The aeromedical assessment should be decided according to comprehensive factors, such as the severity of disease, aircraft type, flight duty and flying mission. and flight experience. Key words: Tuberculosis, meningeal; Central nervous system disease; Infection; Diagnosis; Eligibility determination; Aircrews